Differentials
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Guide de pratique clinique sur la prise en charge de l’otite moyenne aiguëPublished by: Groupe de Travail Développement de recommmandations de première ligneLast published: 2022Richtlijnen voor de aanpak van acute otitis media in de eerste lijnPublished by: Werkgroep Ontwikkeling Richtlijnen Eerste Lijn (Worel)Last published: 2022Otitis media with effusion
SIGNS / SYMPTOMS
Typically the middle ear effusion is asymptomatic. Some older patients may complain of fullness, a popping sensation, decreased hearing or ringing on the affected side.
INVESTIGATIONS
On otoscopy these patients have an effusion of any color, air fluid levels, or bubbles with normal tympanic membrane landmarks. [Figure caption and citation for the preceding image starts]: Otoscopy of otitis media with effusion, showing air fluid levels or bubbles, with normal tympanic membrane landmarksFrom the personal collection of Dr Armengol [Citation ends].
Myringitis
SIGNS / SYMPTOMS
These patients may have no symptoms attributable to the middle ear, or mild pain.
INVESTIGATIONS
On otoscopy there is erythema and injection of the tympanic membrane in the neutral position without other features of otitis media. [Figure caption and citation for the preceding image starts]: Otoscopy of myringitis, showing erythema and injection of the tympanic membrane in the neutral positionFrom the personal collection of Dr Armengol [Citation ends].
[Figure caption and citation for the preceding image starts]: An image of previous patient's normal appearing tympanic membrane before the development of myringitis is provided for comparisonFrom the personal collection of Dr Armengol [Citation ends].
Mastoiditis
SIGNS / SYMPTOMS
There is edema, erythema, and tenderness over the mastoid process.
INVESTIGATIONS
Diagnosis is clinical based on history and examination. A CT scan may be warranted if symptoms are severe (to exclude abscess formation) or if the diagnosis is uncertain.
Cholesteatoma
SIGNS / SYMPTOMS
Patients may present with painless otorrhea and hearing loss. Opacification of the tympanic membrane may lead to a misdiagnosis of AOM.
INVESTIGATIONS
Diagnosis is based on the history and clinical findings. Imaging is rarely necessary.[Figure caption and citation for the preceding image starts]: Otoscopic appearance of cholesteatomaFrom the personal collection of Dr Armengol [Citation ends].
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